What Is The First Step In The Social Security Disability Decision-making Process?

The first step is to determine if the applicant is engaging in substantial gainful activity (SGA), which is essentially a question of whether the person is making too much money to qualify for disability benefits. For 2026, the SGA amount is $1,690 per month. If an applicant’s income exceeds this amount, they are generally considered not disabled and their claim will be denied at this step.

How Does Social Security Assess Income For W2 Employees Versus Self-employed Individuals At Step One?

For W2 employees, Social Security looks at the gross income before taxes and deductions to determine if it exceeds the SGA threshold. Impairment-related work expenses can be deducted from gross earnings for a fair assessment. For self-employed individuals, the evaluation is more complex. There are three tests to determine SGA, and it often requires an attorney to navigate these rules correctly.

What Happens At Step Two Of The Evaluation Process?

Step two involves assessing whether the applicant has a medically determinable severe impairment. Social Security looks for a health condition documented by medical records that has lasted or is expected to last at least 12 months or result in death. The impairment must cause some level of work-related dysfunction, meeting a relatively low threshold for severity.

How Does The 12-month Durational Requirement Affect A Disability Claim?

A disability claim can be denied if the impairment does not meet the 12-month durational requirement. For example, if an applicant recovers from a severe condition within a few months, they may not qualify. However, if the impairment lasts beyond 12 months, the claimant may be eligible for a closed period of benefits if they subsequently return to work.

What Is Assessed At Step Three, And How Can It Lead To An Immediate Approval?

Step three considers whether an impairment meets or equals the criteria of listed impairments, which are serious enough to automatically qualify an applicant for benefits. Meeting the exact criteria of a listing results in immediate approval, while equaling a listing involves the impairment being close enough to the requirements, often needing a medical expert’s input.

How Does Step Four Evaluate A Claimant’s Ability To Work?

At step four, the judge assesses the applicant’s residual functional capacity (RFC) to determine if they can return to their past relevant work, considering both exertional and non-exertional requirements. If the RFC allows for a return to past work, the claim is denied. If not, the process moves to step five.

What Role Does The RFC Play Before Reaching Step Five?

The RFC, which is the maximum capacity an applicant can sustain over a 12-month period, is crucial for determining the ability to perform past relevant work at step four. It encompasses physical activities like sitting and lifting, as well as non-exertional limitations, and sets the framework for evaluating potential future work capabilities at step five.

What Is The Focus Of Step Five In The Disability Evaluation Process?

Step five examines whether there are other jobs in the national economy that the applicant can perform given their RFC, age, education, and work experience. The burden of proof shifts to Social Security to demonstrate the existence of these jobs. If they cannot, the applicant is deemed disabled.

How Do Grid Rules Influence The Decision At Step Five?

Grid rules consider the applicant’s age, education, and work experience alongside their RFC to determine disability status. They provide a structured framework where certain demographics, like older individuals with limited skills, are more likely to be deemed disabled. If the grid rules do not favor disability, a vocational expert may testify on job availability.

What Is The Vocational Expert’s Role In The Hearing Process?

The vocational expert provides testimony on whether jobs exist in the national economy that the applicant can perform, based on their RFC. They assess the types and numbers of jobs available, offering critical input that influences the judge’s decision at step five.